How Worried Should You Be About the U.S.–Based Malaria Cases?
Reading Time: 6 minutesThis happens from time to time. Here’s everything you need to know., Malaria cases in the U.S.: An expert explains how worried you should be about spread in Florida and Texas.
A few people have recently caught malaria in the United States, the Centers for Disease Control and Prevention has warned. Four ‘locally acquired’ cases have popped up in Florida, and one in Texas. The Texas case does not appear to be related to those in Florida.
When someone has malaria in the states—there are about 2,000 cases a year—it’s typically because they’ve been traveling somewhere it’s endemic. Globally, malaria kills hundreds of thousands of people per year, mostly children. And though the toll had been on the decline in recent decades, it ticked up during the height of the coronavirus pandemic. Although Bill Gates has said that he hopes to see malaria eradicated during his lifetime, some experts say that’s optimistic.
But is it particularly worrisome that these cases seem to have originated in the U.S.? Parasites, of course, do not need a passport; as long as an illness is thriving on planet Earth, it can pop up in America. With a CDC health alert recommending that clinicians consider that any mysterious fevers might signal malaria, and the Florida Department of Health advising bug spray and long-sleeved clothing, it’s reasonable to wonder if this is now going to be an ongoing issue in the States too. (Really, on top of everything else, malaria?) After all, we used to have regular malaria transmission in the U.S.; it was eliminated around 1950.
I checked with malariologist Christopher Plowe for his take. He has worked to detect the ‘silent reservoir’ of asymptomatic infections that contribute to malaria’s ongoing presence in some warm climates. He has had the illness himself four times.
Shannon Palus: What was your reaction to the news that malaria is spreading in the States?
Christopher Plowe: ‘Here we go again.’ This doesn’t happen very often. But I’ve been I’ve been working on malaria, gosh, since the mid-1980s. And every—I don’t know—10 years or so, there’s a little outbreak like this in the U.S. We’ve seen it before. It’s kind of strange when it happens.
Why does it happen?
When people with enough malaria parasites in their blood encounter mosquitoes, we get these little outbreaks.
Not all mosquitoes can carry malaria, right?
The Anopheles genus of mosquitoes are the ones that can transmit malaria, and even there, there’s kind of specificity. Certain variants on that particular mosquito are more efficient at transmitting one or another species of malaria.
I’m in Brooklyn. Are the mosquitoes that can carry malaria in my neighborhood?
I can’t tell you for sure, partly because we don’t really do much surveillance anymore for the presence and distribution of mosquitoes. We’ve kind of stopped worrying about malaria in this country once we stopped the ongoing transmission back in the last century.
How did that ongoing transmission in the U.S. stop?
The main intervention that caused malaria to stop being transmitted on an ongoing basis was socioeconomic development. As people began to live inside homes with windows that could be closed, as people got access to diagnosis and treatments, it was really kind of the economic development, and development of our primary health care system, that was responsible, more so than anything, rather than anything specifically targeting mosquitoes or getting rid of breeding sites. Some of that activity went on, but it was really that kind of overall economic development in the last century that resulted in getting rid of malaria.
So, it would be hard for malaria to really start spreading here now.
For all the problems we have with our health care system in this country in general, access to diagnosis and treatment of fever and so forth is pretty good. The likelihood that we would get an ongoing epidemic of malaria is pretty low.
Another reason for that is because we haven’t had ongoing malaria in this country for many years, and therefore we have very little immunity to malaria.
The lack of immunity is helpful in curbing the outbreak? That’s counterintuitive.
If you grow up in sub-Saharan Africa in a place where you’re exposed to malaria, by the time you’re 5 or 6 years old, you have enough immunity that you may still get infected, but you’re not going to get very sick and you’re very unlikely to die from malaria. If you then come to the U.S. or Europe, you may lose that immunity over the course of three, four, five years.
In this country, when malaria appears and people don’t have immunity, they get sick; they seek medical attention. You make the diagnosis, and you get treated. That pretty much stops the outbreak. Having a nonimmune susceptible population means that when it appears, you’ll know it. If we had large numbers of people that could harbor asymptomatic infection, they could serve as a reservoir for ongoing transmission.
So, someone who has immunity might harbor the parasite—and help spread it—without getting sick themselves.
Exactly. When I was an infectious disease fellow at Johns Hopkins, one of my fellow fellows found a case of a woman who had been continuously infected with malaria for 50 or 60 years. She got infected as a young person. Her immune system was able to control the infection in a very low level.
I think she had her spleen removed for cancer treatment or something like that. And then her immune system wasn’t able to control it anymore, and it kind of came up in her blood, and they were able to detect it. People can stay asymptomatically infected, and at least potentially infectious, for years.
We’re all so used to hearing about asymptomatic infections with COVID. But with malaria, it sounds like, if you aren’t immune, you’ll really know if you’re infected. You aren’t going to have an asymptomatic infection randomly. What are the symptoms of malaria?
Well, I’ve had it four times, so I can tell you. Fever is the classic symptom. Fever, chills. Headache is very prominent. But it can have quite a few different kinds of symptoms. So you can get gastrointestinal symptoms, abdominal pain, nausea, vomiting, diarrhea.
In severe cases, you can get involvement of the central nervous system. There’s a syndrome called cerebral malaria, where people’s brains are infected. That’s one of the most severe forms that can be fatal. It can cause a severe anemia. It can affect your liver, your kidneys, cause organ failure. The classic is fever, chills, headache, body aches, and extreme fatigue. You can’t get up and do anything.
OK, so after you’ve realized that you have malaria, what’s the thought process that’s going through your head?
I’m a malaria expert, and when I’m traveling, I’m usually with malaria experts. There’s usually tons of microscopes and testing kits and malaria treatments around, so I might just kind of, you know, take care of it on the fly.
When it happened in this country, my thought process was: get to the ER, let them know that I think I might have malaria, because that might not be the first thing on their mind when somebody comes in with a fever and a headache. And get a malaria test done. And if it’s positive, get treatment started right away.
If you have malaria and you can get diagnosed and treated right away, is there a risk that something terrible will happen, or do we know how to handle it?
You can get really ill and feel very uncomfortable, but you’re unlikely to die.
How much should the average person be worried about the spread of malaria right now in the States?
Oh, the risk is incredibly low. When these outbreaks have happened in the past, offhand I don’t recall reading about any instances where it’s gotten up into the double digits.
OK, but what if you’re in Sarasota, Florida, where four of the cases have been found?
Mosquitoes don’t tend to fly more than a few miles at most. Typically less than that. If you’re in the state of Florida, in general the risk is extremely low.
It’s summertime, it’s hot—I don’t know that it’s reasonable to expect everybody living in an area where there’s a little outbreak like this to start wearing long sleeves and so forth. I think the main thing is awareness. And if you have a fever, particularly if you know that you could have been exposed to malaria, to seek diagnosis and treatment.
If I lived in Sarasota, I might have a lower threshold for getting checked out if I had a fever. Typically, if I had a fever, I might give it a day or two and see if I get better. If I knew that there was a malaria outbreak going on down the road, I would be more inclined to go in and say, Hey, you know, can you check my blood for malaria? If in doubt, get tested.
Reference: https://slate.com/technology/2023/06/malaria-in-the-us-how-worried.html
Ref: slate
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